The impact of the physician-patient working alliance and attachment on lupus treatment outcomes

Abstract

Using an online survey of 193 individuals diagnosed with systemic lupus erythematosus (SLE), this study investigated how elements of the relationship between SLE patients and their physicians affected treatment outcomes. Given psychotherapy research findings that the practitioner-patient working alliance is the single most reliable predictor of treatment success, and medical research findings that individuals with a secure attachment style cope better with illnesses than do others, the investigator hypothesized that the quality of patients' working alliance with their physicians and patients' attachment styles would predict three crucial treatment outcomes: treatment adherence, patient satisfaction, and health-related quality of life. ^ To formulate a model for the physician-SLE patient relationship, the researcher explored interactions between the two predictor variables (the working alliance and attachment style) and the three outcome variables (patients' adherence, satisfaction, and quality of life). The investigator used hierarchical, setwise, multiple regression analyses to test the hypothesis. Results suggested that the working alliance was significantly and positively associated with all three outcome variables of adherence, satisfaction, and quality of life. The attachment style defined as attachment avoidance was significantly and negatively related to adherence, and the attachment style defined as attachment anxiety was significantly and negatively related to health-related quality of life. Neither attachment style was significantly related to patient satisfaction, as the predictive power of the working alliance controlled for their effects. ^ These findings can enlighten researchers and practitioners about the nexus between the physician-patient working alliance, interpersonal characteristics, and health outcomes. The results underscore the need for further clarification of these interactions, in order to create a medical curriculum that can better teach the art of the healing relationship. ^ SLE is one of the most prevalent chronic illnesses, impacting millions worldwide, yet public awareness of it lags behind that of many other diseases. Its unknown etiology, varying signs, difficult diagnosis, debilitating symptoms and incurability contribute to the relative ignorance about this syndrome. But these difficulties also made SLE particularly relevant for the current study, as a strong working relationship between physicians and SLE patients may improve health outcomes even more conspicuously than in more biologically manageable illnesses. ^